Medications to Avoid for Glaucoma Patients

The Healthy Eye

A variety of medications are used by glaucoma patients for varied problems. Some of those frequently used drugs can adversely affect eyes and put you at the risk of developing glaucoma as they have the potential to increase eye pressure. 
This article discusses the medications that might worsen glaucoma. These meds cause narrowing or permanent blockage of the eye drainage system, located around the base of the cornea in the eye. The narrowing of trabecular meshwork increases the risk of glaucoma.

Narrow-angle glaucoma

Narrow-angle glaucoma also called acute angle-closure glaucoma or closed-angle glaucoma – the second most common type – is a largely inherited permanent blockage trabecular meshwork disorder caused by fluid buildup behind the iris. This buildup of fluid causes a dangerous increase in intraocular pressure.

Medications that have anticholinergic properties can negatively affect patients with narrow-angle glaucoma. These drugs block the action of acetylcholine, a chemical messenger that transmits signals from one nerve cell to another nerve cell, muscle cell, or gland cell.

Here is a list of classified medications narrow-angle glaucoma patients must avoid:

Allergies – Diphenhydramine, Ephedrine

Anti-allergy over-the-counter drugs such as Diphenhydramine and Ephedrine that contain diphenhydramine put patients with narrow-angles glaucoma at risk.

Asthma and COPD – Atrovent, Spiriva

Atrovent and Spiriva, used in Asthma may be associated with angle-closure glaucoma attacks.

Depression/Anxiety – Prozac, Paxil, Elavil, Elavil, Vistaril

Some medications used to cure depression can have adverse effects in patients with narrow angles. They may also have some anticholinergic activity and thus should be used in caution. 

Gastric Reflux/Nausea – Tagamet, Zantac, Phenergan

Medications used to treat nausea or gastric reflux have weak anticholinergic that may lead to angle-closure.

  • Incontinence and Overactive Bladder Medications – Detrol, Ditropan 

Migraines/Muscle Spasms – Topamax, Norflex, Artane

Norflex and Artane have been associated with angle-closure glaucoma. Topamax is primarily used for seizures but has a suspicion for closed-angle glaucoma. 

Most of these drugs mentioned above have Anticholinergics. These drugs block the action of acetylcholine, a neurotransmitter or a chemical messenger. Anticholinergics can treat a variety of conditions, including urinary incontinence, overactive bladder (OAB), chronic obstructive pulmonary disorder (COPD) but they aren’t for everyone. 

People with glaucoma shouldn’t use Anticholinergics.

Open-angle glaucoma

Open-angle glaucoma is the most common type and accounts for 70-90 percent of all cases. It is a chronic, slowly progressing, condition that results mainly because of age, structural defects and damage to the trabecular meshwork.

Drugs with steroids must be avoided by open-angle glaucoma patients. Most steroids have the ability to cause permanent blockage of the eye’s drainage system. 

A few of them to avoid are mentioned below:

  • Autoimmune diseases lupus, autoimmune hepatitis
  • Inflammatory bowel diseases – Crohn’s disease, ulcerative colitis
  • Joint and muscle diseases –rheumatoid arthritis, polymyalgia rheumatica

Not everyone is likely to develop elevated eye pressures when taking oral steroids. The risk is higher if you have open-angle glaucoma. However, if you are undergoing treatment for glaucoma and have recently been diagnosed with a condition that requires more chronic use of oral steroids, you should consult with your ophthalmologist. Moreover, short courses and lower doses of steroids may also decrease the risk of increased eye pressure.

Consult an ophthalmologist before choosing your medication

There are other medications that can raise the risk of glaucoma in addition to the ones mentioned in this article. Therefore it is always recommended to talk with your pharmacist or your eye doctor about your medication regimen before bringing it into practice. 

The side effects of drugs vary from person to person based on their health conditions and can only be assessed correctly by an eye expert.


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